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C Exam 5
Perfusion
| Question | Answer |
|---|---|
| What is Perfusion? | the flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells. |
| If there is low perfusion how would that effect the kidneys? | decreased perfusion to the kidneys usually one of the first organs effected. |
| What is ischemia? | insufficient flow of oxygenated blood to tissues resulting in hypoxia and cell injury or death. |
| Can ischemia be reversed? | yes if recognized quickly and you are able to get oxygenated blood to the tissues before cell damage. |
| If ischemia is not treated what can it lead to? | Infarction |
| What is infarction? | death of tissue with inability to regenerate. |
| What is anoxia? | total lack of oxygen in body tissues. ex. brain dead due to lack of oxygen for to long |
| What is central perfusion? | force of blood movement generated by cardiac output |
| What is required for central perfusion? | adequate cardiac function, blood pressure, and blood volume. |
| What is considered an impairment to central perfusion? | inadequate cardiac output. |
| What is tissue or local perfusion? | volume of blood that flow to target tissue. |
| What is required for local perfusion? | patent vessels, adequate hydrostatic pressure, and capillary permeability |
| What is necrosis? | death of most of all of organ or tissue. |
| Which vein is known as the widow maker? Why? | Left Anterior Descending artery, most likely to result in sudden cardiac death. Supplies majority of the left ventricle which pumps the blood to the body. |
| What is the order of the left arteries? | Circumflex artery Left anterior descending artery |
| What is the order of the right arteries? | Coronary veins |
| When do the coronary arteries fill? | during ventricular relaxation |
| What can an increased heart rate cause? | reduced ventricular relaxation which can result in less coronary circulation. Which means less oxygen for the heart muscles when the hearts workload is increased. |
| What does the circumflex artery supply? | left atrium and side/back of left ventricle |
| What does the left anterior descending artery supply? | front and bottom of the left ventricle and front of the septum |
| What are the arteries that can be palpated? | Radial Brachial Carotid Posterior tibial Dorsalis Pedis Femoral Popliteal |
| What is pre load? | volume of blood in the ventricle at the end of relaxation (diastole) before the next contraction |
| What is normal vascular volume? | 4.5-5.5 L |
| What are some factors that can effect pre load? | volume in the intravascular system dilation of the venous system |
| What fluid is used for volume expansion? | Isotonic |
| What is the most commonly used drug that will cause vasoconstriction? | Norepinephrine |
| What does preload determine? | the amount of stretch placed on the ventricle |
| What happens to preload if the venous system is dilated? | would be less in the heart to be pumped it would be chilling in the veins. |
| What happens to preload if the veins are constricted? | if the constriction is effective in sending the small amount of blood to the vital organs, preload should remain the same. Think of toothpaste trying to tighten it to squeeze out that last little bit. |
| What is contractility? | describes the strength of the contraction |
| What would increased contractility mean? | increased emptying of the heart |
| What would decreased contractility mean? | decreased emptying of the heart |
| What does a positive inotrope do? | increases the force of contraction |
| What are the examples of positive inotrope drugs? (SAYING) | Dope Epi Is Dobud (debuting) cALBUM Digging Levo- headed MIL |
| What are the drug names of the positive inotrope drugs? | Dopamine Epinephrine Isuprel Dobutamine Calcium Digoxin Levophed Milrone |
| What does a negative inotrope do? | decreases the force of contration |
| What are some examples of negative inotropes? | Beta Blockers Calcium Channel Blockers Alcohol is also a negative inotrope |
| What is afterload? | the forces opposing ventricular ejection Resistance left ventricle must overcome |
| If there is an increased afterload what would that mean for the heart? | Increased workload |
| What forces oppose ventricular ejection? | Systemic arterial pressure (blood pressure) |
| How can we reduce afterload? | reduce blood pressure through vasodilation or volume reduction Repair malfunctioning valve Reduce the viscosity of the blood |
| What drugs cause vasodilation? | Ace inhibitors Calcium channel blockers Beta Blockers |
| How do beta blockers cause vasodilation? | (↓renin = ↓angiotensin + ↓ angiotensin II = vasodilation) |
| How do calcium channel blockers cause vasodilation? | by relaxing smooth muscle |
| What is the cardiac output? | amount of blood pumped by each ventricle in one minute |
| What is the equation that determines cardiac output? | Stroke Volume x Heart Rate |
| What is stroke volume? | amount of blood ejected from one ventricle during contraction |
| What is the cardiac index? | is the cardiac output adjusted for the patients body size |
| What is a normal cardiac output? | 4-8 L per minute |
| What is a normal stroke volume? | 60-100 ml/beat |
| What is the equation for cardiac index? | cardiac output ÷ Body Surface area |
| What is a normal cardiac index? | 2.5- 4.2 L/min |
| What is a more valuable measurement cardiac output or cardiac index? | Cardiac index |
| What is ejection fraction? | the percent of diastolic volume(preload??) that is ejected from the heart during systole(contraction) |
| What is a normal ejection fraction? | 50-70% |
| What does ejection fraction help rate? | how severe a persons heart failure(pump failure) is |
| A persons EF has to be less than what to be considered for a heart transplant? | less than 10% |
| What is cardiac reserve? | ability of the heart to meet the demands of the body |
| How can cardiac output be increased? | By increasing the HR &/or SV |
| What normal conditions increase cardiac output? | exercise, increased in temperature, stress |
| What are drugs that stimulate the sympathetic nervous system called? | adrenergic agonists |
| What are drugs that inhibit the sympathetic nervous system called? | adrenergic blockers |
| What does the parasympathetic nervous system do? | Rest and Digest |
| Which drugs stimulate the parasympathetic nervous system? | Cholinergic drugs- cause bradycardia and hypotension |
| What do cholinergic blocking drugs do? | turn off the parasympathetic NS causing tachycardia Most common used drug atropine |
| What are the benefical affects of Beta blockers on the CV system? | Decrease contractility Decrease heart rate Decrease renin secretion (decreases sodium and water reabsorption) |
| Why should beta blockers be avoided in patients with respiratory issues, diabetes, and GI issues? | They will work on both Beta 1 & 2 receptors if they are not beta selective. cause bronchial constriction cause glycongenolysis (breakdown of glycogen to glucose) Increase GI mobility (can cause diarrhea) |
| What are chemoreceptors? | intiate changes in the HR and arterial pressure in response to: Increase arterial CO2 pressure Decreased arterial O2 pressure Decreased plasma pH |
| What happens when the chemoreceptors are stimulated? | stimulate the vasomotor center to increase HR and force of contraction |
| Where are chemoreceptors located? | aortic and carotid bodies |
| What stimulates baroreceptors? | volume overload They are sensitive to stretch and increased pressure |
| What happens when the baroreceptors are stimulated? | temporary inhibition of the sympathetic nervous system Causing decrease in HR Peripheral vasodilation |
| What does decreased arterial pressure cause? | Increases HR Causes vasoconstriction |
| What is Angiotension II? | powerful vasoconstrictor |
| So if ace is inhibited what will happen in regards to the RAAS system? | it will cause vasodilation instead |
| What is the pacemaker of the heart? | SA node |
| How many times does the SA node send an impulse per minute? | 60-100 times |
| The impulse travels across the atrium to ..? | the AV node |
| What is depolarization? | contraction of the muscle |
| What is repolarization? | R for relaxation of the muscle |
| What is the order of the heart conduction system? | SA node AV node Bundle of his Bundle Branches Purkinje fibers |
| The electrical transmission produces changes in the ion concentration which creates what? | an action potential |
| What wave on the ECG represents atrial depolarization? | P wave Think pacemaker wave |
| What wave on the ECG represents ventricular depolarization? | QRS interval |
| What wave on the ECG represents ventricular repolarization? | T wave |
| What are calcium channel blockers used for in regards to dilation? | dilate coronary arteries but not veins. Used with MI to increase coronary artery blood supply Used in HTN HF to reduce afterload |
| Calcium channel blockers are what kind of inotrope? | negative, block calcium reducing cardiac contractility |
| How do calcium channel blockers treat HRs? | treat rapid HR by decreasing automaticity at the SA node and conduction at the AV node |
| What do cardiac glycosides do? | Increase contractility Decrease HR |
| What is pulse? | wave of blood created by contraction of the left ventricle and represents stroke volume. |
| How do you measure blood viscosity? | hematocrit: proportion of red blood cells to blood plasma |
| At what percent does blood viscosity increase significantly? | 60-65% |
| When is BP typically the lowest? | in the morning gradually increases to peak late afternoon early evening |
| What is the equation to figure out the MAP? | (SBP + 2 DBP) ÷ 3 |
| A MAP greater than what is required to perfuse the kidneys? | greater than 60 |
| What is considered orthostatic hypotension? | SBP drop of more then 20 DBP drop of more then 10 |
| What is pulse pressure? | difference between SBP and DBP, usually around 40 mmhg |
| How do you test for orthostatic hypotension? | Lying(10mins) Sitting(2mins) Standing (immediate and q2 up to 10min) |
| How is the pulse effected by age? | ↓ with age( average 130 newborn, 80 for adult and 70 for older adult) |
| What does a fever do to pulse? | ↑ pulse in response to lower B/P and ↑ metabolic rate |
| What is the systolic blood pressure? | pressure during contraction |
| What is the diastolic blood pressure? | pressure during relaxation |
| What is BP a result of? | Pumping action of the heart Peripheral resistance Blood volume Blood Viscosity |
| How does age effect BP? | BP increases with age |
| How does menopause effect BP? | females BP increases after menopause |
| How does age effect perfusion? | Elastin decreases Decreased contractility and HR response to stress Which leads to decreased CO and SV |
| What can thickened veins and valvular reflux lead to? | peripheral edema Varicosities Vascular Disease |
| What does arterial stiffening lead to? | decline in peripheral and vital organ perfusion |
| What are non-modifiable risk factors for perfusion disorders? | Age Gender Ethnicity Genetic |
| What are modifiable risk factors for perfusion disorders? | Smoking High Cholesterol Obesity Sedentary lifestyle Hypertension Alcohol |
| What valves are usually affected by lipid accumulation, degeneration of collagen, and fibrosis? | Aortic and mitral valves |
| The pacemaker cells in which node decrease with age? | SA node By 75, may only have 10% of normal # of pacemaker cells |
| b-adernergic receptors | |
| What happens to arterial and venous blood vessels with age? | they thicken and become less elastic with age |
| Age increases arteries sensitivity to what? | Vasopressin |
| What is vasopressin? | anti diuretic hormone |
Created by:
cberna00
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